Key result
Right ventricular global longitudinal strain and transverse strain demonstrated high diagnostic accuracy for detecting right ventricular dysfunction (AUC 0.93 and 0.91, respectively) in patients with ischemic mitral regurgitation.
Why the study?
Does echocardiographic multiplanar strain quantification improve the assessment of right ventricular dysfunction and non-ischemic fibrosis compared to conventional echo indices in patients with ischemic mitral regurgitation?
Cross-Sectional (n=73)
No
Does echocardiographic multiplanar strain quantification improve the assessment of right ventricular dysfunction and non-ischemic fibrosis compared to conventional echo indices in patients with ischemic mitral regurgitation?
Effect estimate: AUC 0.93 (95% CI 0.87-0.99)
p-value: p=<0.001
Multiplanar echocardiographic strain imaging (RV-GLS and transverse strain) provides superior correlation with CMR-derived right ventricular ejection fraction and better identifies non-ischemic fibrosis compared to conventional echo indices in patients with ischemic mitral regurgitation.
May support RV strain integration into ischemic MR echo assessment; hypothesis-generating for superiority over conventional indices.
BACKGROUND: Ischemic mitral regurgitation (iMR) predisposes to right ventricular (RV) pressure and volume overload, providing a nidus for RV dysfunction (RVDYS) and non-ischemic fibrosis (NIF). Echocardiography (echo) is widely used to assess iMR, but performance of different indices as markers of RVDYS and NIF is unknown. METHODS: iMR patients prospectively underwent echo and cardiac magnetic resonance (CMR) within 72 hours. Echo quantified iMR, assessed conventional RV indices (TAPSE, RV-S', fractional area change [FAC]), and strain via speckle tracking in apical 4-chamber (global longitudinal strain [RV-GLS]) and parasternal long axis orientation (transverse strain). CMR volumetrically quantified RVEF, and assessed ischemic pattern myocardial infarction (MI) and septal NIF. RESULTS: 73 iMR patients were studied; 36% had RVDYS (EF<50%) on CMR among whom LVEF was lower, PA systolic pressure higher, and MI size larger (all p<0.05). CMR RVEF was paralleled by echo results; correlations were highest for RV-GLS (r = 0.73) and lowest for RV-S' (r = 0.43; all p<0.001). RVDYS patients more often had CMR-evidenced NIF (54% vs. 7%; p<0.001). Whereas all RV indices were lower among NIF-affected patients (all p≤0.006), percent change was largest for transverse strain (48.3%). CMR RVEF was independently associated with RV-GLS (partial r = 0.57, p<0.001) and transverse strain (r = 0.38, p = 0.002) (R = 0.78, p<0.001). Overall diagnostic performance of RV-GLS and transverse strain were similar (AUC = 0.93[0.87-0.99]|0.91[0.84-0.99], both p<0.001), and yielded near equivalent sensitivity and specificity (85%|83% and 80%|79% respectively). CONCLUSION: Compared to conventional echo indices, RV strain parameters yield stronger correlation with CMR-defined RVEF and potentially constitute better markers of CMR-evidenced NIF in iMR.
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Franco et al. (2017) conducted a cross-sectional in Ischemic mitral regurgitation (n=73). Multiplanar strain quantification (RV-GLS and transverse strain) vs. Conventional echocardiographic indices (TAPSE, RV-S', FAC) was evaluated on Diagnostic performance (AUC) for CMR-defined right ventricular dysfunction (EF < 50%) using RV-GLS (AUC 0.93, 95% CI 0.87-0.99, p=<0.001). Right ventricular global longitudinal strain and transverse strain demonstrated high diagnostic accuracy for detecting right ventricular dysfunction (AUC 0.93 and 0.91, respectively) in patients with ischemic mitral regurgitation.
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